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General NPI Number Information
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NPI Number | 1538468665
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Entity Type | Organization
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Legal Business Name | X-TRA PERFORMANCE & PHYSICAL THERAPY COMPANY
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 1504 KENTUCKY ST
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City | SALISBURY
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State | NC
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Zip | 28144-6500
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Country | US
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Telephone | 704-762-0340
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Fax |
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Provider Business Mailing Address
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Address Line | 1454 GENTRY MEMORIAL HWY
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City | EASLEY
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State | SC
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Zip | 29640-6940
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Country | US
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Telephone | 864-644-2700
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Fax | 864-644-2710
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Authorized Official
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Title or Position | OWNER
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Name | JOEL BURGESS
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Credential |
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Telephone | 704-762-0340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1877
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License Number State | NC
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